COLD OR CANKER?
Alleviating Painful Mouth Sores



(From the Spring 2007 issue of Get Healthy Magazine, a publication of the Times)




By Rick Kaempfer



Canker sores and cold sores seem to be siblings in oral pain.

Both of them are preceded by a tingling sensation in the days before they appear. They look similar, they feel similar, and their names sound similar.

Yet they aren’t related at all.

The best way to differentiate cold sores from canker sores is location, location, location.

When the sores appear outside the mouth, even if it’s on, in, or near the nose, it’s a cold sore. (They can also appear in the eyes, but if they do, seek treatment immediately. That can lead to blindness if not treated.)

When they appear inside the mouth, especially on the tongue, at the base of the gums or inside the cheek, it’s a canker sore.


Cold Sores

Causes
A cold sore is a recurring reminder of a virus that was probably contracted years earlier; HSV-1 or Herpes Simplex Virus-1.

HSV-1 is a very common and highly contagious virus often contracted during the pre-school years. The initial infection is accompanied by a fever and sore throat.

“Kids are miserable when they first get the virus,” Dr. Daniel Bade of Bade Dental Spa in St. John says. “It’s extremely painful in their throats.”

After the initial infection, however, subsequent outbreaks are much milder.

It is estimated that 100 million Americans have acquired the HSV-1 virus, but some people build up antibodies against it, and become asymptomatic carriers. Others are not as lucky. For approximately forty percent of the HSV-1 sufferers, the virus will live in nerve roots indefinitely near affected skin areas, and during exposure to ultraviolet rays from the sun, or periods of stress, lack of sleep, or illness—especially fever, cold sores emerge.

“Any kind of stress can cause a recurrence,” according to Dr. Bade. “Mental stress or physical stress.”


Symptoms
Cold sores are preceded by a tingling sensation in the affected area (usually in the lips) a day or two before the sores actually appear.

This is followed by lip swelling and redness. Fluid-filled blisters emerge a day or two later, and when they burst, painful cold sores are formed. After a few days these sores are covered by scabs, which usually heal completely in eight to ten days.


Treatments
During this tingling stage, cold sores can be suppressed by prompt treatment with anti-viral prescription medications like Acyclovir. This has been a major breakthrough over the last decade.

Once the blisters emerge, however, these medications are not nearly as effective. Topical creams can shorten the healing time, but not by much—at most by a day or two.

“Cold sores can also be treated with cold lasers,” Dr. Bade said. “The only problem with this treatment is that it has to be done at the correct stage. If it’s too early or too late in the development of the sores, laser treatment isn’t effective.”


Prevention
It’s almost impossible to avoid the initial contraction of HSV-1—because virtually everyone has it. It may also be impossible to completely eliminate recurrences once the virus is in the body, but there are ways to minimize future cold sores.

The best way to minimize them is to avoid what causes the eruptions to recur. For instance, using sunscreen on the lips can reduce ultraviolet rays, which in turn can help prevent cold sores. Maintaining a balanced diet, reducing stress level, and getting a good night’s sleep are other ways to minimize recurrences. Avoiding physical contact with others who have active cold sores is yet another way of reducing the chances. After all, HSV-1 is highly contagious.

“Anyone in the ulcerated stage is contagious,” Dr. Bade notes.


Canker Sores


Causes
While the origin and causes of cold sores are well known, researchers still haven’t identified every cause of canker sores (also known as aphthous ulcers).

They have, however, found quite a few. For instance, stress to tissue areas caused by eating jagged foods like nuts or biting the inside of the mouth or cheek can lead to canker sores.

Researchers also believe that canker sores can be caused by bad nutrition, particularly a deficiency of vitamin B-12, zinc, and folic acid. Some food allergies have been identified as canker sore sources too, and the American Academy of Family Physicians also attributes canker sores to menstrual cycles and stress.


Symptoms
Like cold sores, canker sores are preceded by a tingling (or burning) sensation inside the mouth, which is followed by the appearance of painful white or yellow sores surrounded by a red halo.

It can be one ulcer or a cluster of ulcers on the inside of the cheek, at the base of the gums, or on the tongue. They usually heal in several days, but can last up to two weeks.

If canker sores are unusually large or last longer than three weeks, seek medical attention. The sores could be a sign of some other medical condition.


Treatments
Unlike cold sores, however, canker sores don’t respond to preventative medication during the tingling stages. “After the sores emerge, they do respond to tetracycline,” Dr. Bade said, “but the cure is often more painful than the canker sores themselves.”

Over-the-counter pain killers can help reduce the discomfort. Rinsing with warm water and salt can also temporarily soothe the area. Doctors or dentists can even provide a prescription mouthwash or salve, but each of these remedies will only offer temporary relief from the pain.


Prevention
Canker sore prevention is an inexact science. Because some people are more affected by certain acidic foods or spices, and others are more prone to allergies or have cheeks and gums more easily punctured by rough or jagged foods, effective prevention techniques differ from person to person.

The American Academy of Family Physicians, however, recently offered three general tips for canker sore prevention:
*Stay away from toothpastes and mouthwashes that contain irritating ingredients.
*Avoid chewing gum, and very hard, crunchy or spicy food.
*Keep your mouth clean by flossing regularly and brushing after every meal.

Brothers in Pain

Though they may not be scientifically related, canker sores and cold sores do have the most important thing in common as far as the afflicted are concerned: pain.

The good news is that both of them can be minimized. The bad news is that they can’t be eliminated.

At least not yet.